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Free Content Twenty-five years of tuberculosis in a French university hospital: a laboratory perspective

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Abstract:

OBJECTIVE: To determine the impact of recent changes in the epidemiology of tuberculosis in France and other industrialised countries on the primary trends of tuberculosis case rates in a French university hospital.

DESIGN: Descriptive study of all 4549 culture-positive tuberculosis cases hospitalised at Pitié-Salpêtrière Hospital between 1972 and 1996.

RESULTS: From 1972, there was a decline of 5% per year in the tuberculosis case rate, which levelled off in 1983. The proportion of tuberculosis patients who were human immunodeficiency virus (HIV) positive increased from 2% in 1983 to 28% in 1990, and thereafter remained stable. The proportion of foreign-born tuberculosis patients also increased, from 40% in 1972 to 55% in 1985. These two changes affected drug resistance patterns. Drug resistance was more common among foreign-born than among French-born patients, whether previously treated or not. Resistance to rifampicin and multidrug resistance among previously untreated patients was highly related to HIV co-infection. Extra-pulmonary sites of tuberculosis were more often smear-positive in HIV-positive than in non-HIV-positive patients (22.8% vs 12.6%), and bacteraemia was diagnosed almost exclusively in HIV-positive patients.

CONCLUSION: The changes in clinical and bacteriological tuberculosis patterns at the hospital level over the last 25 years have paralleled those observed at national and international level in industrialised countries, including a slowing in the decrease in the case rate, due in part to the HIV epidemic, a higher proportion of foreign-born patients and an increase in drug resistance.

Keywords: HIV infection; M. tuberculosis; drug resistance; epidemiology

Document Type: Regular Paper

Affiliations: Laboratoire de Bactériologie et Hygiène, Groupe Hospitalier Pitié-Salpêtrière, Paris, France

Publication date: 2000-06-01

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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